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Biomedical subjects

J Garfield

Publications and source records attributed to J Garfield.

At least 19 recordsLinked to original sources
PubMed2002

Acute subdural haematoma in a boxer.

On the basis of the judgements of the Court of First Instance, and of the Court of Appeal, (Michael Alexander Watson versus British Board of Control Limited) the causation aspects of two sequential acute subdural haematomas sustained by a boxer, are critically examined. The beneficial effects in this case of 'resuscitation' at the ringside, and its feasibility, are very doubtful. So also are the practicability and benefit of direct transfer to a neurosurgical department, with the timing of operation being advanced by some 45 minutes, or more probably by only 15 minutes.

Adult↗
PubMed2001

The realities of postoperative disability and the carer's burden.

Outcome after high-risk, complex neurosurgery for progressive skull base pathology, and its effect on carers, has been examined. Two different outcome measures were used. The Glasgow Outcome Score (GOS) assesses overall social capability and dependence of the patient, while the 36 item short-form health survey (SF-36), a generic quality of life measure, can be compared directly with the general population. Overall outcome using the GOS indicated a favourable outcome for 13 of the 17 patients studied. The SF-36 demonstrated that more than half the patients were functioning at a level below the accepted norm. The reasons for this discrepancy and the validity of outcome scales have been analysed. In addition, the effect upon carers, its relevance to assessment of outcome, and the need to involve potential carers in the process of informed consent was stated. Our conclusions are applicable throughout the surgical specialities, and especially to high-risk complex surgery.

Caregivers↗
PubMed1999

Outcome after complex neurosurgery: the caregiver's burden is forgotten.

OBJECT: The goals of this study were twofold: 1) to determine outcome, including quality of life, in patients who have undergone surgery for petroclival meningioma in which a standard skull base approach was used; and 2) to assess the impact of the patients' surgical treatment on their caregivers. METHODS: Seventeen patients (13 women and four men ranging in age from 29 to 63 years) who underwent a transpetrosal approach for a petroclival meningioma during a 5-year period were prospectively included in this study. Pre- and postoperative data including adverse events were noted. The patients were assessed at 3, 6, and 12 months postoperatively, and annually thereafter, and they completed a postoperative SF-36 questionnaire. In addition, each patient's caregiver was interviewed to determine the effect of the patient's illness on the caregiver's life and responsibilities. Twenty-two operations were performed. A new permanent neurological deficit developed in five patients and in eight a temporary deficit or exacerbation of existing deficits occurred. Two patients underwent surgery to create a facial-hypoglossal nerve communication; five required a temporary percutaneous gastrostomy and/or tracheostomy; three required a shunt; and one underwent successful squint surgery. At 1 year postoperatively 13 patients had made a good or moderate recovery, three were severely disabled, and one had died--outcomes in keeping with other studies. By contrast, responses to the SF-36 questionnaire showed that, in all eight of its categories, between 43% and 75% of surviving patients were functioning below accepted norms. Fifty-six percent of caregivers experienced a major change in lifestyle and 38% experienced a major change with respect to their work. CONCLUSIONS: After transpetrosal excision of a petroclival meningioma, the quality of life for the patient is worse than that indicated in surgeons' reported results. The impact on the patient's caregiver is profound-a burden perhaps not fully appreciated by the surgeon.

Adult↗
PubMed1998

Retrovirus-mediated transduction of porcine keratinocytes in organ culture.

Direct transfer of new genetic information to keratinocytes in epidermis may prove effective in treating certain genodermatoses; however, current methods for in vivo gene transfer to skin do not lead to persistence of the transgene. The goal of this study was to explore direct gene transfer using retrovirus-mediated transduction. Retroviral vectors integrate a DNA copy of their genome into the host chromosome and therefore have the potential to effect a permanent gene therapy. To facilitate development of methods for in vivo transduction with retroviral vectors, a porcine skin organ culture model was constructed in which the denuded surface was repopulated with replicating keratinocytes from hair follicles and epidermal remnants. In situ transduction was carried out by topical application of two retrovirus vectors, MFGlacZ (10(7) blue forming units per ml) and LZRN pseudotyped with the G protein of vesicular stomatitis virus (VSV) (10(9) colony forming units per ml), each encoding the beta-galactosidase reporter gene and the latter encoding the neomycin phosphotransferase selectable gene. Beta-galactosidase expressing cells were observed more frequently with LZRN than with MFGlacZ; however, transduction efficiency remained low in both instances. At equivalent titers, the VSV-G pseudotyped retroviral vector was shown to transduce porcine keratinocytes more efficiently than a similar vector with the amphotropic envelope. The number of beta-gal+ cells in organ culture could be increased by selection of LZRN-transduced cells in situ with G418. To achieve transduction of epidermis in vivo, these studies point out the importance of high titer retroviral vectors, pseudotyping with VSV-G protein, and in situ selection.

Animals↗
PubMed1986

Present status and future role of surgery for malignant supratentorial gliomas.

Despite a voluminous literature it remains difficult to draw conclusions about the precise place of surgery in the management of patients with supratentorial malignant gliomas (anaplastic astrocytoma and glioblastoma multiforme). If the beneficial effects of radiotherapy are discounted, excisional surgery itself probably achieves no more than a survival of 4 to 6 months. The apparently beneficial effects of excisional surgery are related more to radiotherapy than to the surgery itself, beyond the immediate relief of raised intracranial pressure. So far in EORTC Brain Tumour Group studies there is no evidence of any significant beneficial effect from chemotherapy after excisional surgery. Whatever adjuvant methods of therapy are developed in the future, it will remain necessary to separate the effects of surgery from those of the adjuvant therapy. There will therefore be a continuing need for a basic human model whereby the effects of surgery can be clarified, and for that reason it will always be necessary to have a treatment arm without excisional surgery. A format is proposed taking into account favorable prognostic factors such as age and Karnofsky index, which should provide a basis for critical evaluation. The difficulties of adhering to the format are stressed.

Astrocytoma↗
PubMed1980

Carbachol triggering of desynchronized sleep phenomena: enhancement via small volume infusions.

Two physical factors affecting the behavioral effects of drugs microinjected into the pontine tegmentum have been studied. Reducing the volume of vehicle produced a dramatic enhancement of the capacity of the long-acting cholinergic agent carbachol to induce desynchronized (D) sleep-like behavior (Dcarb). Enhancement of Dcarb was also achieved by substitute passive diffusion for active pumping of a given volume of carbachol solution. Controlling these two physical factors makes Dcarb a compelling experimental model for the study of D sleep mechanisms. The results also give support to the concept of a localized population of cholinoceptive neurons in the pontine reticular formation whose activation is a key step in the generation of physiological D.

Animals↗
PubMed1980

Alienated labor, stress, and coronary disease.

The concept of alienation is used to integrate research findings on the relationship of occupational stress to coronary disease risk. The analysis takes the objective aspects of alienated labor (lack of control over the work process, loss of the product through appropriation, and competitive and fragmented work relations) and the subjective dimensions of alienation (sense of powerlessness, dissatisfaction, and frustration) as categories within which certain occupational factors in coronary disease can be subsumed. These categories are placed within a broader social analysis and critique, and it is suggested that chronic stress and alienation may be reduced as workers gain increased control over the process and product of their labor.

Coronary Disease↗
PubMed1978

If I had.

Explore the source record for details and available documents.

Craniocerebral Trauma↗
PubMed1978

Subarachnoid haemorrhage above the age of 59: are intracranial investigations justified?

Out of 186 patients aged over 59 referred to a neurosurgical department after spontaneous subarachnoid haemorrhage, 143 underwent cerebral angiography; only 28 (15%) of the patients had surgery, of whom 16 were independent one year later. The doubtful benefit of surgery and the small proportion of patients who underwent surgery have economic and ethical implications; in particular, neurosurgical beds and neuroradiological facilities should not be occupied by such patients if this delays the admission of younger patients and those requiring investigation of intracranial space-occupying and spinal lesions.

Age Factors↗
PubMed1975

Delay in diagnosis of optic nerve and chiasmal compression presenting with unilateral failing vision.

Out of 29 patients who presented with failing vision in one eye due to optic nerve or chiasmal compression, compression was initially diagnosed in only five. The errors in diagnosis and lack of ophthalmological follow-up led to delays of up to many years with serious deterioration in acuity before referral for intracranial investigation. The chief causes of error were lack of charting of the visual fields, too ready acceptance of the diagnosis of the neuritis in the absence of essential features, and the infrequent use of skull radiographs.

Adolescent↗
PubMed1969

Management of supratentorial intracranial abscess: a review of 200 cases.

TWO HUNDRED CASES OF INTRACRANIAL SUPRATENTORIAL ABSCESS HAVE BEEN REVIEWED: 100 spanned the years 1951 to 1957, and 100 the years 1962 to 1967. The mortality rate of 40% was the same in both series, chiefly owing to continuing inaccurate localization of the abscess and inadequate use of antibiotics. The hazards of lumbar puncture are real, and this procedure is contra-indicated when convulsions, signs of a hemisphere disturbance, or papilloedema are present. Of the methods for localizing intracranial abscess the site of E.N.T. sepsis, ventriculography, and brain scanning were found to be the most valuable. Penicillin in high dosage continues to be the most important antibiotic. The results of assiduously repeated burrhole aspiration compare favourably with those of later excision.

Adult↗